The IT journey in clinical systems in Singapore dates back to the 1980s and by the early 2000s, two distinct electronic medical record (EMR) systems emerged from the two integrated clusters. However, this meant that sharing of patient information, especially those moving from different clusters, was a big challenge.

In 2008, the National Electronic Healthcare Record (NEHR) was conceived out of a âone patient, one recordâ vision based on a concept paper. Critically, NEHR differs from previous EMR systems as it is a repository of visit summaries specific to a n individual. While EMR systems contain detailed information of a patient in their respective institutions, NEHR collects key subsets of health information from these multiple healthcare encounters.

NEHR went live in 2011, with the successful uploading of healthcare information from public hospitals in the same year. By the first year, all restructured hospitals, specialist centres and polyclinics, six community hospitals, eight nursing homes, and an increase from an initial 50 to 250 GP clinics had access to NEHR.

HealthHub, a one-stop portal and mobile application for Singaporeans to access a wide range of health content, rewards and e-services was launched in 2015. Users can also log-in to HealthHub through their SingPass to view their health records and medical appointments across different polyclinics, public hospitals and other public health institutions. The information from HealthHub is drawn from a few IT systems, which include the NEHR, the School Health Syst em, School Dental System and National Immunisation Registry.

As of November 2017, only three percent of the more than 4,000 private healthcare providers â" including specialist clinics, nursing homes and hospices â" contribute to the NEHR scheme. Additionally, a study of private healthcare institutions done by the Integrated Health Information Systems (IHiS), the national technology agency for healthcare, found that two in 10 private GPs and specialist clinics still use written medical record systems, rather than an electronic one. At the time of writing, the Ministry of Health (MOH) website has a list of 1230 healthcare institutions/organisations (public and private) who are participating in NEHR.

Due to the slow uptake by private healthcare sector in the NEHR, MOH wants to make it compulsory for all healthcare providers to upload data to the NEHR. Early adopters who start contributing data by June 2019 will be able to claim a one-off from MOH to offset their costs of upgrading their systems and a S$20 million fund has been set aside by the ministry for this purpose.

One of the unique developments is that the latest generation of the Singapore Armed Forces (SAF)âs EMR system, Patient Care Enhancement System (PACES) 3, which was launched in April 2016, connects to healthcare infrastructure outside of Ministry of Defence (MINDEF)/SAF via the internet, such as the NEHR. This helps to provide more holistic care for SAF servicemen. Traditionally, the first two generations of PACES operated independently on their own with no ability to connect to external healthcare infrastructures.

While there has been a progressive development in health IT in Singapore in terms of the NEHR and HealthHub, the nation-state suffered a setback in its goal to becoming a Smart Nation when a cyberattack occurred to SingHealth, Singaporeâs largest group of healthcare institutions, which consists of 4 public hospitals island wide, 5 national specialty cen tres and a network of 9 polyclinics in July 2018. Described as one of the worst cyberattacks in the country, the incident saw the personal information of 1.5 million SingHealth patients being copied and stolen.

Plans for compulsory contribution to NEHR has been suspended temporarily after the SingHealth incident and a four-member Committee of Inquiry (COI) was set up promptly to look into the events and factors that led to the attack. In response to the incident, Prime Minister Lee Hsien Loong shared, âIf we discover a breach, we must promptly put it right, improve our systems, and inform the people affected. This is what we are doing in this case. We cannot go back to paper records and files. We have to go forward, to build a secure and smart nation.â